Utilizing Mega Planning Theory in the Development of a New Graduate Medical Education Program: A CLER Vision

Transcription

1 Florida State University College of Medicine Internal Medicine Residency Program at Sarasota Memorial Hospital Utilizing Mega Planning Theory in the Development of a New Graduate Medical Education Program: A CLER Vision W. Wiese-Rometsch, MD Joan Y. Meek, MD 1

2 Disclosures W Wiese-Rometsch, MD JY Meek, MD None of the above speakers have any conflicts of interest to report. 2

3 Acknowledgements Heidi Kromrei, PhD Associate Designated Institutional Official, Detroit Medical Center David Verinder, President & CEO Sarasota Memorial Health Care System Stephen R. Taylor, MD, CMO, Sarasota Memorial Health Care System Robert Smith, PhD Professor of Clinical Sciences & Research, Florida State University Internal Medicine Residency Program at Sarasota Memorial Hospital Karen Hamad, MD Associate Program Director and Immediate Past Chief of Staff, Sarasota Memorial Hospital 3

4 Objectives 1. Identify opportunities for GME Program(s) to add value to society in their community 2. Apply principles of Kaufman s Mega Planning and Organizational Elements Model in the design of a new GME program a. Identify and incorporate key stakeholders in the strategic planning process b. Create program mission / vision / aims that align at the mega, macro, and micro levels c. Identify barriers and discuss possible solutions 4

5 Outline Introduction to FSU Model for Graduate Medical Education Description of Mega Planning Theory and Performance Model Application to the GME residency development Identification of stakeholders needed to accomplish defined goals and their potential contributions to the mega vision Defining performance metrics Identification of potential barriers and develop means to overcome them 5

6 FSU Model Service to the elderly, rural, minority, and underserved 6

7 Regional Medical School Campuses TMH/DATFL SMH Regional Campus Rural Track Site LH GME Programs Tallahassee Memorial HealthCare Dermatology Associates of Tallahassee Sarasota Memorial Health Care System Lee Health 7

8 FSU s Role in GME Expansion Problem: Florida has the 3 rd largest population (20 million) 30/50 states in terms of active primary care physicians per 100,000 population 41/50 states in the number of GME positions per 100,000 population Newly accredited Florida medical schools & increase in medical school graduates Need for more GME positions in the state Solution: Partnership with clinical institutions & joint decision making Emphasis on: primary care, care for the underserved, rural, geriatric populations 8

9 How Does the FSU Model Work? Use of technology Synchronous orientation Graduate Medical Education Committee Close liaison with hospital leadership 9

10 Challenges of Our Model Oversight Multiple hospital partners CLER may not always be CLEAR! Resident interaction 10

11 Are you planning to start a new GME program? 11

12 Mega Thinking & Planning Focus on strategic planning to help define and achieve organizational success How can we use our organization as a primary vehicle for adding value to society? If our GME program is the solution, what is the problem? 12

13 Alignment in Program Planning Mega Macro Micro Based on Organizational Elements Model; Kaufman,

14 Organizational Alignment 14

15 External Client & Societal Contributions (Mega) Organizational Contributions (Macro) Organizational Accomplishments and Contributions (Micro) Ends Activities, Programs, Processes, Interventions (Processes) Resources (Human, Financial, Physical) (Inputs) Kaufman R (2011) The Manager s Pocket Guide to Mega Thinking and Planning. Amherst, MA:HRD Press Means 15

16 Mega Planning Steps 1.Ideal Vision, Indicators, and Targets 2.Current status with regards to ideal vision 3.Gap between desired and current state 4. Prioritize gaps based on costs and consequences 5.Mission objectives and functional objectives 6.Analyze and Implement Solutions Kaufman R, Guerra-Lopez I; Needs Assessment for Organizational Success; 2013 ASTD Press 16

17 The Ideal Vision Belief and assumption that the primary purpose of every person and every organization is to create a better world for the Child of Tomorrow The Ideal Vision 17

18 The Ideal Vision Access and delivery of health care Disease prevention and wellness Population Health 18

19 Mega Planning Steps 1.Ideal Vision, Indicators, and Targets 2.Current status with regards to ideal vision 3.Gap between desired and current state 4. Prioritize gaps based on costs and consequences 5.Mission objectives and functional objectives 6.Analyze and Implement Solutions Kaufman R, Guerra-Lopez I; Needs Assessment for Organizational Success; 2013 ASTD Press 19

20 Current Status & Gap Characteristics Sarasota Newtown Race/Ethnicity White alone 91% 55.2% Black or AA alone 4.9% 37% Hispanic 8.8% 15.7% Health Without insurance <65 y o 19.8% 28.5% With disability, < % 12.2% Income & Poverty Per capita income 12 mos. $33,300 $18,416 Median household income $42,000 $24,497 Persons in Poverty 10.8% 33.5% Access to Food Plentiful Food desert Sarasota is the 6 th richest county in Florida 20

21 Community of Newtown 21

22 Macro Level: SMH & FSU 22

23 Mission To educate and develop exemplary physicians who practice patient-centered health care, discover and advance knowledge, and are responsive to community needs, especially through service to elder, rural, minority & underserved populations. Internal Medicine Residency Program To provide health care services that excel in Caring, Quality and Innovation To train residents that are outstanding, comprehensive board certified internists; able to provide excellent care to our patients, particularly the underserved and elderly populations 23

24 24 Sarasota Memorial Health Care System 2017 MISSION To provide health care services that excel in Caring, Quality and Innovation. VISION Our community will be served by the best health care system in America. SMHCS will be the best place to be a patient, the best place to work, and the best place to practice medicine. Strategic Road Map 2017 VALUES Caring & Compassion; Excellence Teamwork & Trust; Mutual Respect & Recognition; Accountable/Ethical Behavior Geographic Reach Population Health Community Engagement Destination Programs Reputation Patient-Centered Care Innovation Quality Finance Patient Experience Areas of Focus Newtown Internal Medicine Practice Others Areas of Focus GME Program Launch Others Areas of Focus Patient Safety Initiatives (higher reliability) Others Areas of Focus Triple Aim Focus Synchronization Others Community Programs Patient Outcomes

25 Alignment with ACGME & CLER The ACGME s mission is to improve health care and population health by assessing and advancing the quality of resident physicians education through accreditation. The CLER Program focus areas Patient safety Health care quality (including health care disparities) Care transitions Supervision Fatigue management, mitigation, and duty hours Professionalism 25

26 SMH: Safety Net Hospital Mission Services & Community Programs Fiscal Year 2016 Bad debts $27.2 Million Traditional Charity Care $15.5 Million Medicare Losses $33.8 Million Medicaid Losses $19.1 Million Emergency Care Center call & subsidy $ 9.4 Million Anesthesiologist, Hospitalist & Psychiatric coverage $ 6.5 Million Clinics and Community programs $ 3.4 Million Indigent care fund $ 8.6 Million TOTAL $123.5 Million 26

27 SMH Outpatient Visits: Charity, Indigent, Self-Pay 27

28 SMH ED Returns: Charity, Indigent & Self-Pay 28

29 Rationale for Internal Medicine Residency Continuity Clinic in Newtown Problem: 52% of population is below poverty level* Solution: Provide access to internal medicine clinic to adults in the community in which they live Metrics: Decrease use of Emergency Department as source of primary care Provide follow-up and continuity care to discharged patients Decrease hospital readmissions for the un(under)insured * 29

30 The Impact Evaluation Process o f u o nu dn da a t t i i o n Add societal value Results Data Analysis Data Collection/Data Sources Design Evaluation Plan (objectives/performance indicators) Determine Key Decisions and Develop Evaluation Questions Develop Conceptual Model of Program Identify Stakeholders and Expectations a l i g n m e n t Add societal value Kaufman R, Guerra-Lopez

31 Fourteen Steps to Useful Results 1. Decide to Create a Better Future 8. Determine likely causes of needs 9. Identify alternative methods- means 2.Define partners and stakeholders 7.Determine change requirements 10.Select appropriate methods-means 3.Obtain commitment 6. Prioritize and select needs 11. Make, buy, or obtain methodsmeans 14.Revise and Improve as required 4.Commit to a Mega (societal focus) 5.Identify needs at Mega, Macro, and Micro 12.Implement and manage 13.Determine effectiveness and efficiency Kaufman & Stone; 1982 Kaufman, Oakley Browne, Watkins, Leigh;

32 Identifying Key Stakeholders Organizations: SMH Leadership (C-suite) FSU/SMH Residency Program SMH Pharmacy Program FSU GMEC Newtown & Other Groups: Mayor Willie Shaw Newtown Redevelopment Office Community & Church Leaders Booker High School Principal Legal Aid Manasota Good Samaritan Pharmacy Glasser Shoenbaum Human Services Center SCOPE Food Pantry 32

33 Stakeholders Identified Contributions/ Role Meetings SMH Leadership * (Board, C-Suite) FSU/ SMH IM Residency Program Commitment to build state of the art facility and provide staff to operate Develop, design, implement vision, provide resident and faculty physicians; participate in clinic design Monthly Weekly SMH Architectural Group/ IT Group* Clinic plan design; EMR ; others Monthly, Weekly Mayor of Sarasota * Relationship building with community, strategy, permits 4 Newtown Redevelopment Office * Relationship building with community 4 Community Physician Leaders Liaison with community 4 Community Leaders Liaison with patients 4 Legal Aid Manasota Provide on-site free legal counsel for issues impacting health 2 SMH Pharmacy Residency Program Provide on site pharmacist and resident 3 Booker High/ Middle Schools Glasser Schoenbaum Human Services Center Shadowing opportunities for High School Students, STEM funding; artwork for practice Provide additional resources (behavioral care, counseling, literacy, sex counseling, others); immersion experience for IM Residents All-Faiths Foodbank * Provide clients with healthier food options 1 SCOPE Provide data on human services outcomes and indicators 1 Community Events * Christmas parties, MLK Ceremony, others 6 Philanthropists * Provide sources of funding for initiatives 3 * Attended by selected by selected C-suite Representatives

34 The Glasser/Schoenbaum Human Services Center 18 non- profit health and human services agencies housed in 1 location Help low income and at risk adults, children and families achieve and maintain productive lives as contributing members of the community Services for Adults & Seniors: Behavioral Healthcare Epilepsy Services Legal Services Family and Children s Services Healthy Start Literacy Council More Too Life Salvation Army Partnership to End Homelessness 34

35 Newtown Community Involvement: Booker High School Promotion of Health Promotion of STEM Programs Career development through shadowing: Healthcare (Physicians, Pharmacists, Nurses) Lawyers Social Workers Students to provide artwork to display in the clinic 35

36 Micro Level: Program, Residents, Faculty, Patients Newtown Immersion Program for Internal Medicine Residents Community events Meet the Residents MLK Jr. Day Festivities Tree Lighting Ceremony Experiential learning Food bank Home visits Tour Glasser-Schoenbaum Human Services Center Structured didactics (ie- health care disparities) Participation in High school mentoring program 36

37 Why Measurement? What Doesn t Get Measured Doesn t Get Done. Or at least it doesn t get done very well If you re not consistently measuring that which should be measured you re probably not managing that which should be managed. Guerra-López (2009) 37

38 Measuring Performance Accomplishments vs. Predetermined Standards Feedback Data-driven decisions H. Kromrei, PhD; based on works by Kaufman, Rumler, Guerra-Lopez 38

39 The Ideal Vision Access and delivery of health care Disease prevention and wellness Population Health 39

40 Measurable Indicators Ideal Vision (Mega) Ideal Targets Performance Indicator All adult patients will have access to primary care provider All Newtown adults will be provided internal medicine care in their community # of adult patients seen in clinic compared to adult patient population Decrease adult ED utilization for non emergent visits Decrease hospital readmissions by ensuring adequate follow-up All adults will utilize continuity clinic for non emergent conditions All discharged patients will have a physician visit and/ or phone call within 7 days of discharge # of adult patients seen in ED from Newtown # discharged patients that were seen or contacted within 7 days # discharged patients that were not seen or contacted within 7 days 40

41 Measurable Indicators Ideal Vision Ideal Targets Performance Indicator All patients will have access, availability and affordability of healthy food options All Newtown families will have access, availability, and affordability of healthy food options Total number reporting access points that offer healthy foods (farmer s market, grocery stores) # of existing access points # referrals to food bank # referrals to nutrition/ cooking classes # of individuals eligible for government food assistance 41

42 Measurable Indicators Ideal Vision Ideal Targets Performance Indicator All adults with nutritional based comorbidities will receive appropriate counseling and interventions All Newtown adult patients will have a normal BMI All diabetics will be adequately controlled % of patients with normal BMI % of diabetics controlled Prevalence of obesity Prevalence of diabetes # of referrals to nutritionist # of prescriptions for exercise 42

43 Measurable Indicators Ideal Vision (Mega) Ideal Targets Performance Indicator Patients are able to obtain and afford medications All Newtown patients will have access to prescribed medications # of patients unable to afford medications # of Referrals to Good Samaritan Pharmacy Patients will not experience health- harming legal issues. All Newtown adult patients will have access to free medical-legal counsel to address health harming legal needs. # of Referrals to Legal Aid Manasota # of Patients with increased disability that quality for additional benefits 43

44 Measurable Indicators Ideal Vision (Mega) Ideal Targets Performance Indicator All adults will have age and gender appropriate evidence-based prevention interventions 100% compliance with prevention interventions Rate and adequacy of prevention interventions -immunizations -hyperlipidemia -colorectal cancer screening -mammography -others Referrals to SMH Community Clinic 44

45 Mega Planning Steps 1.Ideal Vision, Indicators, and Targets 2.Current status with regards to ideal vision 3.Gap between desired and current state 4. Prioritize gaps based on costs and consequences 5.Mission objectives and functional objectives 6. Analyze and Implement Solutions Kaufman R, Guerra-Lopez I; Needs Assessment for Organizational Success; 2013 ASTD Press 45

46 Beginning Mega Planning Process The table below may assist you in getting started at your institution. Mega Level Vision Current state Desired State Stakeholders Contribution to Mega Performance Metrics Please refer to handout. 46

47 Take Home Points 1. If your GME program is the solution, what is the problem? 2. What is the Ideal Vision for your community as and how can your GME program contribute to that vision? 3. Ensure alignment of mission & vision at mega, macro and micro levels. 4. Identify, engage, and obtain commitment of stakeholders. Inclusive of the C-Suite. 5. Identify performance metrics and reassess. How do these metrics impact the mega vision and our stakeholders? 47

48 Questions? 48